Evaluation of metoprolol standard dosing pathway in Chinese patients with acute coronary syndrome: a prospective multicenter single-arm interventional study / 老年心脏病学杂志（英文版）

OBJECTIVE@#To evaluate the feasibility and tolerability of metoprolol standard dosing pathway (MSDP) in Chinese patients with acute coronary syndrome (ACS).@*METHODS@#In this multicenter, prospective, open label, single-arm and interventional study that was conducted from February 2018 to April 2019 in fifteen Chinese hospitals. A total of 998 hospitalized patients aged ≥ 18 years and diagnosed with ACS were included. The MSDP was applied to all eligible ACS patients based on the standard treatment recommended by international guidelines. The primary endpoint was the percentage of patients achieving the target dose at discharge (V2). The secondary endpoints included the heart rate and blood pressure at V2 and four weeks after discharge (V4), and percentage of patients experiencing bradycardia (heart rate < 50 beats/min), hypotension (blood pressure < 90/60 mmHg) and transient cardiac dysfunction at V2 and V4.@*RESULTS@#Of the 998 patients, 29.46% of patients achieved the target dose (≥ 95 mg/d) at V2. The total population was divided into two groups: target group (patients achieving the target dose at V2) and non-target group (patients not achieving the target dose at V2). There was significant difference in the reduction of heart rate from baseline to discharge in the two groups (-4.97 ± 11.90 beats/min vs. -2.70 ± 9.47 beats/min, P = 0.034). There was no significant difference in the proportion of bradycardia that occurred in the two groups at V2 (0 vs. 0, P = 1.000) and V4 (0.81% vs. 0.33%, P = 0.715). There was no significant difference in the proportion of hypotension between the two groups at V2 (0.004% vs. 0.004%, P = 1.000) and V4 (0 vs. 0.005%, P = 0.560). No transient cardiac dysfunction occurred in two groups during the study. A total of five adverse events (1.70%) and one serious adverse event (0.34%) were related to the pathway in target group.@*CONCLUSIONS@#In Chinese ACS patients, the feasibility and tolerability of the MSDP have been proved to be acceptable.

Radial artery thrombosis in optical coherence tomography guided transradial coronary angiography and percutaneous coronary intervention in acute coronary syndrome patients and its risk factors analysis / 中华心血管病杂志

Objective: To observe the radial artery thrombosis (RAT) during transradial coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) by optical coherence tomography (OCT), and to investigate the risk factors of RAT during the CAG and/or PCI. Methods: In this retrospective study, we consecutively reviewed the radial artery OCT examination results of the patients who underwent OCT guided transradial CAG and/or PCI for acute coronary syndrome in heart center of Beijing Luhe hospital, Capital Medical University from October 2017 to July 2018. The incidence of RAT was observed. The patients were divided into the RAT group and non-RAT group, clinical data were collected and compared. Moreover, the types and distributions of thrombus in radial artery as well as the acute radial artery injuries under OCT were observed. Univariate analysis followed by multivariate analysis were performed to identify potential risk factors. The radial artery patency and ischemic symptoms of the involved limb were followed up at the 24-hour and the 1-month after procedure. Results: A total of 107 patients were included, the age was (58.1±12.5), and 78.5% were male (n=84). The incidence of RAT was 26.2% (n=28, 95%CI 17.9%-34.5%), and the main type of thrombus was white thrombus (n=15, 53.6%). The commonest position of RAT was the proximal portion of radial artery (n=17, 60.7%). The median thrombus volume was 0.05(0.03, 0.38) mm3, and the median thrombus score was 6.5 (3.3, 13.8). In univariate analysis, the frequency of acute radial artery injury and use of bivalirudin were significantly higher and the procedure time was significantly longer in RAT group than those in non-RAT group (all P<0.05). Multivariate regression analysis showed that the radial artery acute injury (OR=5.82, 95%CI: 2.09-16.20, P=0.001) and the procedure time (OR=1.04, 95%CI: 1.01-1.06, P=0.006) were independent risk factors of RAT. Rate of radial artery occlusion at 24 hours follow-up was similar between RAT and non-RAT group (7.14%(2/28), vs. 10.13%(8/79), P=1.000). None of the patients complicated severe ischemic symptom of the operative limb. Conclusions: RAT is a high frequency access complication during transradial coronary intervention. This phenomenon can be accurately observed by OCT. Acute radial artery injury and prolonged procedure time are risk factors of RAT during transradial coronary intervention.

Efficacy and Safety of Intravenous Urapidil for Older Hypertensive Patients with Acute Heart Failure: A Multicenter Randomized Controlled Trial

PURPOSE: Urapidil is putatively effective for patients with hypertension and acute heart failure, although randomized controlled trials thereon are lacking. We investigated the efficacy and safety of intravenous urapidil relative to that of nitroglycerin in older patients with hypertension and heart failure in a randomized controlled trial. MATERIALS AND METHODS: Patients (>60 y) with hypertension and heart failure were randomly assigned to receive intravenous urapidil (n=89) or nitroglycerin (n=91) for 7 days. Hemodynamic parameters, cardiac function, and safety outcomes were compared. RESULTS: Patients in the urapidil group had significantly lower mean systolic blood pressure (110.1±6.5 mm Hg) than those given nitroglycerin (126.4±8.1 mm Hg, p=0.022), without changes in heart rate. Urapidil was associated with improved cardiac function as reflected by lower N terminal-pro B type natriuretic peptide after 7 days (3311.4±546.1 ng/mL vs. 4879.1±325.7 ng/mL, p=0.027) and improved left ventricular ejection fraction (62.2±3.4% vs. 51.0±2.4%, p=0.032). Patients given urapidil had fewer associated adverse events, specifically headache (p=0.025) and tachycardia (p=0.004). The one-month rehospitalization and all-cause mortality rates were similar. CONCLUSION: Intravenous administration of urapidil, compared with nitroglycerin, was associated with better control of blood pressure and preserved cardiac function, as well as fewer adverse events, for elderly patients with hypertension and acute heart failure.

Cause of in-hospital death among acute myocardial infarction patients undergoing primary percutaneous coronary intervention in Beijing / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the cause of in-hospital death among acute myocardial infarction patients undergoing primary percutaneous coronary intervention (PPCI) in Beijing area to evoke better individualized preventive approach.</p><p><b>METHODS</b>In-hospital mortality and causes were analyzed based on database from Beijing percutaneous coronary intervention registry study (BJPCI Registry) in 2010.</p><p><b>RESULTS</b>A total of 4660 PPCI patients from 48 hospitals were included. In-hospital mortality was 2.4% (n = 110). Cardiogenic shock (39.1%, 43/110), mechanical complications (28.2%, 31/110) and intervention-related complications [28.2%, 31/110: procedure related (n = 28), drug related (n = 3)] were the leading causes of in-hospital death. Five deaths was attributed to comorbidity related reason (4.5%, 5/110). The in-hospital mortality had no significant difference among hospitals of different grade or total annual PCI (all P > 0.05). In-hospital mortality was slightly higher in hospital with annual PPCI < 300 than in hospitals with annual PPCI ≥ 300 (2.9% vs. 1.8%, P < 0.05).</p><p><b>CONCLUSION</b>Cardiogenic shock, mechanical complications and intervention-related complications are the main causes of in-hospital death among acute myocardial infarction patients receiving PPCI.</p>

Complications of intertrochanteric fracture treated with dynamic hip screw: cause analysis and prevention / 中国骨伤

<p><b>OBJECTIVE</b>To analyze causes of the complications in treatment of the intertrochanteric fractures with dynamic hip screw (DHS) and discuss the way of the prevention.</p><p><b>METHODS</b>Sixty-five cases of intertrochanter fractures of femur were treated with DHS. Among them, the complications occurred in 13 cases, their causes were analyzed and corresponding preventive treatments were discussed. The patients with complications included 8 male and 5 female, and the mean age was 70.2 years (range, from 56 to 82 years).</p><p><b>RESULTS</b>The major complications of 13 cases included proximal femoral cortex broken in 2 cases, femoral heads penetrated by screw in 2,varus deformity of hip in 5, necrosis of femoral head in 1, the wound infection in 3 (including bone non-union in 1).</p><p><b>CONCLUSION</b>The main causes of the complications are various as follows: the nonstandard operative procedure, incorrect aseptic measures, unsatisfactory reduction, and too early weight bearing. Therefore, appropriate preventive measures such as correct aseptic manipulation, effective treatment of general medical illness,formal operative procedure good reduction, proper fixation of lesser trochanter and posteromedial bone fragment, and correct functional training program should be taken.</p>